Pediatric Surgery and Pediatric Minimal Access Surgery, NSCB Government Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Department of Surgery, NSCB Government Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Eur J Pediatr Surg. 2022 Apr;32(2):177-183. doi: 10.1055/s-0040-1721771. Epub 2020 Dec 30.
The high-type anorectal malformations (ARM) are conventionally managed by an initial left iliac fossa sigmoid colostomy, followed by laparoscopic anorectoplasty (LARP). Such a stoma occupies left half of the infraumbilical region and hinders the LARP ergonomics, leading to the surgeon's discomfort. We studied the outcome and impact of "lateralizing" (shifting laterally in the abdominal wall) the colostomy on port ergonomics.
This prospective study was conducted in the pediatric surgery unit of a medical college in central India between March 2014 and June 2017 in two parts. In the first part of the study, neonates with high ARM were block randomized in two groups: conventional colostomy (CC) in left iliac fossa and lateral colostomy (LC, laterally placed abdominal colostomy). Outcomes of colostomy were compared among these two groups. In the second part of the study, 40 consecutive infants from both types of colostomy groups underwent ergonomic comparison and assessment of the surgeon's discomfort during LARP (CC-LARP and LC-LARP). Standard statistical tests were used for comparison.
In the first part of the study, 203 ARM cases were included in this study; 100 underwent CC and 103 underwent LC. Colostomy prolapse, excoriation, reversed stoma, and short distal limb were significantly higher in the CC group. In the second part of the study, the LC-LARP group showed many significant advantages over the CC-LARP group, including less peri-stomal adhesions, better vision, shorter operative time, and better ergonomics (better manipulation, elevation, and azimuth angles). The LC-LARP also significantly reduced the surgeon's discomfort.
Lateralization of high-sigmoid colostomy should be preferred over left iliac fossa sigmoid colostomy for ARM, as it improves the port ergonomics and reduces the surgeon's discomfort for second stage LARP.
高位型肛门直肠畸形（ARM）传统上采用初始左侧髂窝乙状结肠造口术，然后进行腹腔镜肛门直肠成形术（LARP）。这种造口占据了下腹部中线左侧的一半，阻碍了 LARP 的手术操作，导致外科医生感到不适。我们研究了将造口“侧向化”（在腹壁上向侧面移位）对端口手术操作的影响。
这项前瞻性研究于 2014 年 3 月至 2017 年 6 月在印度中部一所医学院的小儿外科病房进行，分为两部分。在研究的第一部分中，将患有高位 ARM 的新生儿采用随机分组的方法分为两组：左侧髂窝的常规造口术（CC）和外侧造口术（LC，位于腹部的外侧造口术）。比较了两组之间的造口术结果。在研究的第二部分中，对来自两种造口术组的 40 例连续婴儿进行了手术操作比较，并评估了外科医生在 LARP 期间的不适（CC-LARP 和 LC-LARP）。采用标准统计检验进行比较。
在研究的第一部分中，共有 203 例 ARM 病例纳入研究，其中 100 例接受 CC，103 例接受 LC。CC 组的造口脱垂、擦伤、逆行造口和短缩的远端肢体明显更多。在研究的第二部分中，LC-LARP 组在许多方面明显优于 CC-LARP 组，包括更少的造口周围粘连、更好的视野、更短的手术时间和更好的手术操作（更好的操作、提升和方位角度）。LC-LARP 还显著减轻了外科医生的不适。
对于 ARM，应优先选择高位乙状结肠造口术的侧向化，而不是左侧髂窝乙状结肠造口术，因为它可以改善端口手术操作，并减少第二阶段 LARP 时外科医生的不适。
